The NHS will not be able to meet the demands of people with long-term conditions such as diabetes and asthma unless it changes, according to the health secretary.
There will be a 252% increase in the number of over-65s with one or more such conditions by 2050, Andrew Lansley said.
Mr Lansley said the NHS needs to change if it is to cope with the growing numbers, including providing more support to keep people out of hospital, which also saves money.
But the head of the Royal College of Nursing (RCN) said Mr Lansley’s NHS reforms are leading to thousands of job cuts, including among nurses who specialise in long-term conditions.
Dr Peter Carter said the cuts will put vulnerable patients at risk and the reforms will cost billions.
Mr Lansley’s overhaul of the NHS, which will see 80% of the budget handed to GPs to commission services, has come in for widespread criticism.
Several unions have raised fears over the increased use of private companies, while doctors, nurses and midwives have raised concerns about the impact on patient care.
Figures from the Department of Health show people with long-term conditions are the biggest users of the NHS, accounting for about 50% of GP appointments and 70% of inpatient hospital beds.
Mr Lansley said: “An increasing number of people are living with long-term illness, and increasingly two or more serious illnesses.
“The average cost of someone without a long-term condition is around £1,000, which rises to £3,000 for someone with one condition and to £8,000 for people with three or more conditions.
“The additional associated cost pressure of caring for people with multiple co-morbidities could reach £4 billion by 2016.
“That’s one reason why we need to modernise the health service and the way we care for patients.
“There isn’t a one-size-fits-all solution to our health - particularly for those who have a number of different conditions.”
Mr Lansley said the “modernised NHS” will see local health experts in charge, who will have the “power and the budget to put the overall health of their patient first.”
Sir John Oldham, national clinical lead for quality and productivity for the NHS, said: “If we continue to manage people with long-term conditions as we do now, the NHS is not sustainable.
“We have unwittingly created a more fragmented system.”
He said patients received “sub-optimal care” if they were cared for by lots of different people in a fragmented service rather than one team.
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